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HomeMy WebLinkAbout020-1177-90-000 § � ° % o / 0 i ~ el » # � R � G � It 2 . ) z U. . c ■ .0 e 2 � / § 0 � m § f ) b \ z ƒ 2 / z $ 7 / E 2 a o ) b 0 � k 2 .. } E ) a 2 � 3 k k 04 2 © § I gaf (D � § % ' � o o a k E .0 R U) L f / \ E m '6 •� # � a a a t . \ o B § ; . m = . U) -j § § ƒ � \ \ k 6 = a R o E i 2 � I o 0 2 CD ° © LO . a / E 2 £ ) § L SO \ j § ¥ @ 0 S E E F- o c = a o & / £ § $ 2 %_ � a � ' � § \ / � ckRE � - \ / = 7 - o a m § 2 t IL AL \ AL � \ E � ) o 0 a 10 0 , poiForm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER eltl TOWNSHIP Z46,W 'a,(> SEC. T N-R lQ W ADDRESS ST. CROIX COUNTY, WISCONSIN 5y61G' SUBDIVISION Ce4l,r IhK; �/� LOT / 17 LOT SIZE -J ctci^r-7 PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 � SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lk i 5/ Y J INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used $'az m qp 42Sq ll,5— Elevation of vertical reference point: ��. Proposed slope at site: 1�c SEPTIC TANK: Manufacturer: 411e� Liquid Capacity: /000 , Number of rings used: _ Tank manhole cover elevation: — Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side,@ Rear,./ Qa ev /.sd feet From nearest property line Front 10 Side,O Rear,O /a23 fer Number of feet from: well 1f1d ' //dbuilding: (Include this information of the above plot plan)( 2 reference dimensions to septic SEE REVERSE SIDE ey PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: Z2 Len$th: Number of Lines: ;2 Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,®Ft .�� � Number of feet from well: ll Number of feet from building: .2 -7 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: l Dated: Plumber on job: License Number: � ��� 3/84:mj k _ COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 C t` ST. CROIX ZONING REPORT NO., 01x50/01 RAGE 1 ST. CROIX COUNTY REPORT DATE, 2/08/91 COURTHOUSE DATE RECEIVED, 2/06/91 HUDSON: WI 54016 ATTN, THOMAS C. NELSON OWNER. Craig Cotburn LOCATION, 565 Cty Rd. IJU# Hudson COLLECTOR: M. Jenkins SOURCE OF SAMPLE, Kitchen faucet COLIFORM, 0 /100 01 INTERPRETATION, Bacteriologically SAFE NITRATE-N, 4 ppm Above 10 ppm exceeds the recommended Public Drinking Wafter Standard. Coliform Bacteria/100 mL Nitrate—Nitrogenr mg/L i LAB TECHNICIAN, Pam Gane WI Approved Lab No. 19 OF.\NDEDENbE 1, ig C Means "LESS THAN" DetectabLe LeveL Approved by, o PROFESSIONAL LABORATORY SERVICES SINCE 1952 -COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT N0.4 01112/01 PACE 1 ST. CROIX COUNTY REPORT DATE# 1/31/91 COURTHOUSE DATE RECEIVED# 1/29/91 HUDSON, WI 54016 ATTN# THOMAS C. NELSON OWNER# Craig & Alison Colburn LOCATION# 565 Cty Rd. W, Hudson COLLECTOR# M. Jenkins SOURCE OF SAMPLE# Kiichen faucet COLIFORM# 6 /100 ml INTERPRETATION# Bacteriologically UNSAFE NITRATE-N# 5 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate—Nitrogen, mg/L LAB TECHNICIAN# Pam Gane WI Approved Lab No. 19 OFA DEPENDEM�9 o < Means "LESS THAN" Detectable Level Approved by# �� o PROFESSIONAL LABORATORY SERVICES SINCE 1952 r rf COMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 = 962 - 5227 F ST, CROIX ZONING REPORT NO.t 41112/01 ST. CROIX CITY REPORT DATE: 1/31/91 PAGE 1 { COURTHOUSE DATE RECEI 1/29/91 � HUDSONt WI 54016 tiATTN2 THOMAS C. NELSON x OWNERS Craig & Alison Colburn ' LOCATIONS 565 Cty Rd, W, Hudson COLLECTORS M. jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORMS 6 /100 mt INTERPRETATIONS Bacteriologically UNSAFE NITRATE-NS 5 ppm Above 10 ppm exceeds the recommended Public ; Co l i form Bacteria/100 m i Drinking Water Standard. Nitrate-Nitrogen, mg/L y T LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 OF.\NDEOEp f D H� �: 4s f 0 i C Means "LESS TW" Detectable Level Approved by! o PROFESSIONAL LABORATORY SERVICES SINCE 1952 Ck` ST. CROIX COUNTY ZONING OFFICE i St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Zoning and water i nspInstitutions? Realty Firms, and p private individuals. Completion of this form is ease ntia! sv that the vronerty can be locate d• Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.000 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING _ (For VOWS) ---FEE: $25.00 °� SEPTIC SYSTEM INSPECTION--- -----_- (Determines if system is properly functioning at time of inspection) Property owner's name t � Property owner's address G " Legal Description 1/4 of the 1/4 of Section , T N-R Town Of Lot Number Subdivision Name 6 ao_ 11'Y �757*�-'5 Color of house ' Realty sign by house?_y�j_If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPri Or Puna aWK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: 11+ G� �Cxr Telephone Number REPORT TO BE SENT TO: : Closing date 4-6-6, Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 - (715) 386-4680 _�IW Jan. 28, 1991 Jim Lagoon Burnet Realty 2020 Washington Ave. Stillwater, MN 55082 Dear Mr. Lagoon: An inspection of the septic system on the property of Craig & Alison Colburn, located at 565 Co. Rd. UU, Hudson, WI was conducted on Jan. 28, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis . Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operations of this system. It is recommended that the system should be pumped once every three years . Therefore , the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions, feel free to contact me at this office. Sincerely, Mary J: Jenkins Assistant Zoning Administrator cj •.�.' '.;;� Form Approved OMB No."00 OOBa HEALTH AUTHORITY APPROVAL — INDIVIDUAL VA CASE N ' WATER-SUPPLY AND SEWAGE-DISPOSAL - �-- IMN)i I ANT '1'hic r.­,shoulA 1•f rnngdcrfd and w0 as requi,rA I.y r%kiing law Ja It.S C.1 H04 and 18111. PART I—TO BE COMPLETED BY VA MORTGAGEE NAME AND ADDRESS(Include ZIP Code) MORTGAGOR OR SPONSOR TCF Mortgage Corporation a PROPERTY ADDRESS 7984 Brooklyn Blvd 5(.5 Brooklyn Park, Mn 55445 '9&& County Road UU Hudson, WI54016 SUBDIVISIONILOT NO. Lot 19 Cedar Hills Estates TOTAL NUMBER IS THF.nE A BASE- ST I HIS A NEW CAN THE ATTIC OR OTHER AREA BE MADE INTO MENI? IN57ALLAIION? ADDITIONAL BEDROOMS?it/"Ves."Anwmany7l LIVING UNITS BEDROOMS BATHS [3 YES ❑NO []YES []NO ❑YES 0 N WATEH SUPPLY BY: SYSTEM DESIGNED FOR ❑PUBLIC SYSTEM ❑COMMUNITY SYSTEM ❑INDIVIDUAL NO.OF BEDROOMS GARBAGE DISPOSAL SEWAGE DISPOSAL BY: ❑PUBLIC SYSTEM ❑COMMUNITY SYSTEM ❑INDIVIDUAL C3 YES ❑NO PART II--TO BE COMPLETED BY HEALTH DEPARTMENT OR COMPLIANCE INSPECTOR INSPECTOR'S SKETCH('I'O REPORT AS-BUII.7'DF.VIATIONS FROAf APPRUVFD PLAN/ t/ It is the opinion of the ❑State ®Count y ❑Local dIh that this Individual water-supply system 9 is ❑Is not satisfactory as a domestic water supply for ll,e subject property. It is the oj,inion of the ❑Slate 11...I 1 I ®County ❑Local that this Individual sewage-disposal system with proper maintenance® can be expected to function satisfactorily,and is not likely to create unsanitary conditions 0 cannot be expected to function satisfactorily. DAT/EJ�� ATURE i \ _— TI E NOTE::The health authority should complete the appropriate opinion statement above and affix date,signature and title in the.r.­ptovided- NOTE:Use of the reverse of this form is at the option of the health authority. PART III—TO BE COMPLETED BY VA I have reviewed the foregoing and the pertinent Compliance Inspection Report and recommend that the individual water-supply system be considered ❑acceptable❑:not acceptable and that the sewage-disposal system be considered❑ acceptable ❑ not acceptable. UAI E SIGNATUHB OF CHIEF APPHAISAL SECTION OR DESIGNEE VA 1-O iM 266395 EXISTING STOCKS OF VA FORM 188395, MAY 1385 ,APR 1982,WILL BE USED. SEC 1ION I #it V011 I'01 I IUN-INUIVIDUAL, -DISPOSAL S'l I.PfiI&IAIlY IfILATMENr(0wokone) 1)rSEP I It;TANK ❑ CESSPUUL DISTANCE k HUM WELL MAI LIUAL INSIUL LLNUIII iN!ADL­­t, A ere- ft. -NO.OF�OMPARTMENTS INLET LUMPAR I'MEN I CAPACITY LIQUID CAPACITY jNSIDE DEPTH I i'. gal. gal. ft. 'PISTANCE FROM WE UISF.1140M FOUNUAI ION DISi.FROM NEAREST LOT LINE/Check uplirop.box and insert distance) 13.CESSPOOL ft. - -- ft.1-0 FRONT CTSIDE ❑-REAR ft.INSIDE 79E-FiTl i— LI&&`i1D CAPACITY LINING MA1 ERIAL ft. ft. 1 2.SECONDARY TREATMENT(Check une) DISPOSAL SEEPAGE P HER S T- ...- -----!-T . -1 m xei DISTANCE FROM WELL DIST.FROM FOUNDATION DIST.FROM NEAREST LOT LINE 10jeck approp.box and insert distance) 7 yj " ft. oq 7 ft. 0 FRONT ❑ SIDE M'REAR ft. TOTAL LENGTH OF LINES NO.OF L121 TRENC11WIDTH DISTANCE III- EACH LINE A.DISPOSAL ft. *IT fL ft. FIELD — DEP—THOF FILTER MATERIAL HENEAIH LINE DEPTH(Finish Slade to top fhne) TOTAL ABSORPTION AREA Butfulnuftlench"s) sq.ft. DEPTH OF F ILTER MATERIAL OVER LINE I YPL OF 1-R.I EH MA I t:HIAL(Oocc*) GRAVEL ❑ 11410KENSIUNI, ❑ 111HEII(St,retly) DISTANCE FROM WELL DIST.FROM.OM FOUN"ii6N DIST.-FROM NEAREST LUT*L'INE(Click uppeop.1wx and insert distance) B.SEEPAGE ft. FRONT ❑ SIDE ❑REAR ft. PITS OUTSIDE OIAMLIEH UEP11H NO.Of PITS LINING MATERIAL _ft. _ ft.___ ___ DATE OF INSPECTION SIGNATURE AND TITLE OF I iWEiiiR^ INSPECTION BY: gc:z- 0 -7 -/V-80 ❑ LOCAL STATE X COUNTY DAUTHORITY HEALTH SECTION If. REPORT OF INSPECTION—INDIVIDUAL WATER•SUPPLY SYSTEM TILE SEWER FOUNDATION DIST.FROM NEAREST LOT LINE(Check approp•boxand insert distance) A.WELL it. It. ❑ FRONT ❑ SIDE ❑ REAR ft. I'Disfutti,e CAST IRON SEWER SEPTIC TANK SEEPAGE PIT CESSPOOL DISPOSAL FIELD OTHER SOURCES OF POSSIBLE I POLLUTION It. ft. ft. ft. It. DIAMETER DEPTH TYPE CASING AND DIAMETER CASING DEPTH APPROX.YIELD PER MINUTE in. ft. ft. gal. B.WELL APPROX.UEPTH TO PUMPING LEVEL OF WATER SEALED WATER FIGH r 10 DEPTH OF WELL COVEII(()leek) CONSTRUC- TION ft. ft. ❑ CONCRETE 1:1 WOOD 1:1 MET L OPENINGS IN WELL COVER WA fERTIGHT? EXTERIOR SPACE AROUND CASING SEALED WITH(Check) ❑ YES C3 NO ❑CEMENT GROUT ❑ PUODLED CLAY ❑ CROINATlY BACKFILL TYPE PUMP WELL(Check) LENGTH Of DROP P PUMP CAPACITY-1 T Y- PER PUMP LOCATION(0seck) MINUTE P"AOOM OFF E SHALLOW WELL' ❑ 1111MEIT❑ BASEMENT ❑ SUBMERSIBLE []PU.1..USE ABOVE gal. 0 PUMP PIT GROUND DEEP WELL C.PUMP -Q—�r-: ,- --- - � ­ — PumpRoom PRorEHLY DRAINED? PUMP MOUNTING WATER fIGH)? TYPE STORAGE(Cheek) CAPACITY ❑ YES ❑ NO ❑YES ❑ NO ❑ PRESSURE Cl.-GRAVITY gal. NEAREST P--U-B-Ll`C-WATER'MAIN -INDIVIDUAL WELLS CUSIOMARY IN NE IGHGORIIOOU pi lopERTIES BEING OFVE LOPED WITH BOTH INDIVIDUAL NEIGHBORHOOD? WATEH-SUPPLY AND SEWAGE-DISPOSAL SYSTEMS? ft, 1:1 YES ❑ NO ❑YES ❑ NO SIZE OF NEAREST PUBLIC WATLH DWELLING SET BACK FHUM FRONT INDIVIDUAL WATER SUPPLY FROM(Check type) MAIN PROPERTY LINE DUG in. it. ❑ WELL 011ILLED ❑ WELL OfIIVEN ❑ WELL 1:3 WELL BORED D.OTI IF ft LOT SIZE: GIVI MOST RECENT FAILURE OF WELLS IN IMMEUIAIE VICINITY TO FURNISII AN AOEQUA1 E WATER SUPPLY: FACTORS WIDTH It. DEPTH ft. HAS BACTERIOLOGICAL EXAMINAIIUNUFWATLH DUALITY OF WATER IS SATISFACTORY FUR HUMAN INsrAI.LATION COMPLIES WITH APPROVED BEEN MADE? CONSUMPtION? EXHIBITS,IF ANY? ❑ YES I// ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO DATE OF INSPECTION SIGNATURE AND TITLE OF INSPECTOR INSPECTION BY: LCAL l__1 SIAIE C] COUNTY ❑Cj AUOTHOnITY HEALTH U.S.Goveanniont Printing 011im 1916-161-286/331141 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING ' P'.O.BOX 7969 MADISON,WI 53707 State Plan LD.Numbec ` ❑ NWT, NE 4, S28,T29N—R19W CONVENTIONAL ALTERNATIVE llfa.,�9naal ❑ 'Town of Hudson Holding Tank ❑In-Ground Pressure El Mound G -ot 19 Cedar Hills NAME OF PERMIT HOLDER. AODRE SS OF PERMIT HOLDER: INSPECTION DATE I William Harwell County UU, Hudson, WI 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF,PT.ELI V.. Name of Plumber. MP/MPRSW No County: Sanitary Permit Number: William Schumaker 6382 St. Croix 112679 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER OVES PROVIDED Y YES ❑NO ❑YES�NO BEDDING. VENT DIA.: VENT MATL.. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING.(VENT LE FRESH �-�I /� ALARM LINE ?� AIR INLET ❑YES LJNO 4 G.L ❑YES NO FEET NEARF: ( 04 t \.+ DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHONMANUFACTURER WARNING LABEL LOC KING COVER PROVIDED: PROVIDED: OYES ONO DYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WE WILDING AIVENTT75FRESH R INLET (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) 1:1 YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER E AL ND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. IN O.OF DISTR.PIPE SPACING COVER INSIDE DIA -PITS LIQUID BED/TRENCH ^ TRENCHES tt 1 MATERIAL' PIT DEPTH DIMENSIONS C7+ to l.0 GRAVEL DEPTH FILL DEPTH �I'LETVRIPN'LET IS PF DISTR.PIPE DISTR.PIPE MATERIAL. NO DI NUMBER OF PROPERTY WELL BUILDING. VENT TO F RESH BELOW PIPES ABOVE COVER ELEV.�E ND'. ^ PIPES^ FEET FROM LINE AIR INLET rj.l r� ?, d"{ of NEAREST-----w �`� p►� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES 1:1 NO SOIL COVER ITE XTURE PEHMANENTMAHKERS OBSERVATION WELLS 1:1 YES NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES ENO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. ND.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE M . NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. DIA. ELEV, PIPES DI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS CAL LIFT CORRESPONDS TO APPROVED DYES ❑NO COMMENTS: PERMANENT MARKERS:❑YES ❑OBSEORVATION WELLS. NUMBER OF PRIOEPERTV WELL: BUILDING. FEET FROM ❑YES 1:1 NO ❑YES 1:1 NO NEAREST �L\ . Sketch System on Retain in county file for audit. Reverse Side. NATURE. TITLE. DILHR SBD 6710(R.01/82) Zoning Admi .istrator LHR SANITARY PERMIT APPLICATION ZTY ::X: I In accord with ILHR 83.05,WIS.Adm. Code STATE SANITARY PERMIT# .� ..v. It / —Attach complete plans(to the county copy only)for the system,on paper not less than STA PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION ,/ f e.)e, '/ ,r '/4, S T.9,7, N, R & E (or PROPERTY OWNER'S MAILING ADDRESt LOT NUMBER BLOCK NUMBER SUBDIVISION NAME C 1v ter.! -z/ 6(_//` S C /47 IfeeifeL v AK"l CITY,STATE ZIP CODE PHONE NUMBER =CITY NEAREST ROAD,LAKE OR LANDMARK .� <` .. D/ ` VILLAGE: II. TYPE OF BUILDING OR USE SERVED: , Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. KNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary.Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in##2) 1. a. K Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): I7G 3 l� �7" Q� Feet WIPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): // , Plumber's Signature:(No Stamps) /MPRSW No/J: Business `Phone Number: Plulm,her's Address(Street,City,State,Zip Code): Name of Designer: 16cde a V, �a �6 v l 50016V VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# �o fffg' 41/ CST's ADD S(Street,City,State,Zip Cod—e) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY X ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)4/:a Approved ❑ Owner Given Initial ffharge Fee Adverse Determination O JC_ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANrrARY PERMIT' APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitteed to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground AtBr included the creation of surcharges (fees) for a number of regulated practices which Wisco i#t'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re.. 6t4' is used in your building is returned to the groundwater through your soil absorption e system,or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to-the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development b4 intended for resale by owner/eontractpr. ("spec house"), than a second form should be retained And completed when-the' property is sold and submitted to this office with the appropriate deed recording. ' Owner of Property l.uuatluu of Property Section ,T, T N - R W Mai i I.ing Address Ap Subdivision Name I.ot Number Z c7 Proviuus Owner of Property -Ijr®' Z,0 xaaa,-;� 'Dotal. Size of Parcel de Uac..: Parcel was Created Are all ,corners and lot lines identifiebl®7 Yes No Is this property being developed for resale (spec house) 1 e Yes �� No VC)lume ��� and Page Number 4s::rocorded with the Register of Deeds INCLUDE WITH THIS APPLICATION .ONE OF THE FOLLOWI:NGz 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, Would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Kap shall also be required. PROPERTY OWNER CERTIFICATION I (we) eenti by that aU a.tatemente on the jww axe true to the beet 06 my (oun) hn&A0d9e; that I (we) am lane) the O*WA(.&) 06 464 po i dwAaed n thin in6aRnw�t%on 6uAM, by vcntue o` a watUU$4 dead 4a the 06 jiee o` the County Regi WeA o 6 Deeda ae Voeulm t No. A-1/.?/-7 1 i and that I Iwt 1 ptesentty own the pxopobed b.i,tg ``on the i&APOS-4pten ton I (wt) have obta ned an easement, to sun wri A the above do Gibed pwpen ty, Jon, the eo na tAuc:t i.o n o6 a a+i.d a ya te+m, and the sake has been duty n eeo4ed in the OW ee o6 the County Regiate)i of Oeedi, ae Voc wAt No. /J/ 7f 1 SIUNkrURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 1)ATH SIGNED DATE SIGWEU ,C.UMENT NO,: STATE BAR OF WISCONSIN F M 11-1982 THIS SPACE RESERVED FOR RECORDING DATA € LAND CONTRACT `t , F~J Individual and Corporate �Et�1WUS OFFi^i 1 J (TO BE USED FOR ALI. TRANSACTIONS WHERE OVER $25,000 IS FINANCED A IN OTHER NON-CONSUMER ACT TR NSAC TRANSACTIONS) ST. CROIX CO., wis. Recd. for Record this 11th ContraCt, by and between ....Harry J. Stewart as Personal day of June A.D. 19 86 Representative of the Estate of Aldro Larsen a/k/a John p} 11 :45 A i -------------------------------------------------------------------•------------ __Aldro _Larsen_ a/kf a_ John.. Myren Larsen}_-�*_ ("Vendor James -O Connell - -------- whether one or-,more) and William--C.—Harwell _ Ise N Dwd *single man ("Purchaser", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy formance of this contract by Purchaser, the following property, together with the rents,profits, fixtures and other appurtenant interests (all called the"Property"), St. Croix County, State of Wisconsin: in_______________.....................................................t RETURN TO See legal Description on Addendum Tax Parcel No. ................................... 38e qa?3 1 '�iANS"rj3j, FFF This ...... s__not.......... homestead property. (is not) Purchaser agrees to purchase the Property and to pay to Vendor at ,such Place as he shall name the sum of $--192x500.00.................................... in the following manner: (a) ------- ----------_- __ at the execution of this Contract; and (b) the balance of $•132_,500_ ................. together with interest from date hereof on the balance outstanding front time to time at the rate of-----.........t-�LA.. 10.7)...-....... per cent per annum until paid in full, as follows: See Payment Terms on Addendum Provided, however, the entire outstanding balance shall be paid in full on or before the--------11th _ day of ---------junie----------------........ 19---4.Q_ ( the maturity date). Following any default in payment, interest shall accrue at the rate of---10.___% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due.To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount liiay be prepaid without premium or fee upon principal at any time.314tik xxxxxxXXxxxX c $�cxxx� } tko:x w:z�.:bi�xilmtx2 cxalmtx�c�ilssxvradx�at �s�nnistrcoxmfxVerzlcha�s� In the event of arty prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the iIgr ikkpayments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on.......the__d4te__hereof_________________ egg 'Cross Out One. LAND CONTRACT—Individual and STATF. BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. Corporate ,.�•- FORM Nu. 11—1982 Milwaukee, Wis. Purchaser promises to pay When due all taxes and assessments levied on the Property or upon Vendor's.in'. st. in it and to deliver to Vendor on demand receipts showing such payment. I _ Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire,-Ex, tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved br Vendor, in the sum of $....... .......n/a-------------------------- but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain tae standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to in:;orance companies and Vendor. Unless Purchaser find Vendor otherwise agree in writing, insurance proceeds shall he applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be nu:ai�;illy feasible. Purchaser covenants not to commit waste nor allow waste to he committed on the Property, to keep the Propertll in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the tinies and in the manner above specified Vendor will on demand, execute and deliver to the 'urchoser a �tScOtH e d in Jee simple, of the Property, free sand clear of all liens and encumbrances, except ersona'l Rep ress n a v s any lens or encumtrances created by the act or default of Purchaser, and except: ....easements ..Prot ectime.. cov_enants__af__.record,.__if--any,.--and--zoning__ardi.nanee--requi.zementss...........-............................ -- -----------•------•--•---•--------....._..................--•-•-••-----•----_.. ._....------........---•-...-----------•------... .............................................................. ............... ....... •---------------------...----------•-----------•----------••---- ------------•-------•-------........................ .......•----•--. ...--•---------•-- •• •. -• Purchaser agrees that time is ofthe essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of ---6:Q...days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of AD-_-- days following written notice thereof bY Vendor (delivered personally or mailed by certified mail),then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property hack through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the (late of default at the rate in effect on such date and other amounts due hereunder(in which event all amounts previously pail by Purchaser shall be forefeited as liquidated dannases for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may site at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall he included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) --vithout the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first pf:id in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness Purcha, a edness of Purchaser. In the event of any such transfer, sale of conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Co ntract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by P Purchaser shall this Contract. 1 be considered payments made on Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject P deed to be made in fulfillment hereof.) g 1 Property and agrees to join in the execution of the Dated this ....-_11th June ...................... day of .......... ---------- --------•-•---•-------------•-------------•.., • (SEAL) m./.:7��1�1!�f�Jtl._J' ,. AL) * Harry.._J.....S.tewart............... (SEAL) _.G %+... --- * * William C. Harwell J Q &A- AUTHENTICATION AC KIN Uiiii LED GR3ENT'�O,'.�f:`�:� Signatures) STATE OF WISCONSIN ............................................ --------------------•------------------------•--------•-----. St. sa. ..Croix....................County. authenticated this ........day of.......................... 19...... Personally came before me this ......day of I� _.--_._._.June_______________________I 19-86.. the above named ------------------••----•--..._.........----....---•--------•......------------. J -PANTY.. Harwell ------------•-•-----------------------------•----•---..........------•-- TITLE: MEMBER STATE BAR OF WISCONSIN (.If not, .._.._._... authorized by § 706.06, Wis. Stats.) to me known to be the person S.......... who executed the j foregoiin .nstrument and acknowledge the.same. THIS INSTRUMENT WAS DRAFTED BY Lois--A Murra - Fi)YWOOD CARI -HURRAY & SHERBURNE, P.O. BOX 229, �1) 2S'OJ✓ ------------------------- County. Wis. Hudson;•-iftl--•5.401fr............................................. Notary Public .._ to �roix.................... (Signatures may be authenticated or acknowledged. Both My Commission is per anent. If no state expiration are not necessary.) ` date: _� .,� 19...._.. ) 'lames of persons signing in any capacity should be typ.0 or printed be! r signatures. ^.ONTBACT—Individual and Corporate—State Bar of Wisconsin. 11—1982 .1461 70AA87 LAND CONTRACT ADDENDUM Legal Description The NJ of the NJ of the SEI 'of Section 28-29-19 , except the South 100 feet of the East 565 feet thereof , and except a parcel of land located in the NEI of the SEI of Section 28 , T29N, R19W, Town of Hudson , St . Croix County , Wisconsin, described as follows : Commencing at the Ej Corner of said Section 28 ; thence S89 037146 11W (assumed bearing referenced to the monumented East-West I Section line of said Section 28 , bearing assumed S89 137146 11W) 23 . 78 ' along said East-West line to the point of beginning; thence continuing S89 037146 11W 1301 . 48 ' along said line to the West line of said NEI of the SE4 ; thence S 0 003144 11W 661 . 63 ' along said West line ; thence N89 034148 11E 761 . 971 ; thence N 0 005112 11W 100 . 001 ; thence N89 034148 11E 535 . 401 ; thence N 0 030138 11E 560 . 56 ' along the Westerly right-of-way line of U. S. Highway 1112" to the point of beginning. NEI of Section 28-29-19 , except that parcel described as Lot 1 of a C. S.M. recorded in Vol . 3 of C. S.M. ' s , page 862 as Doc. No. 359579 and except that parcel described in Vol . 583 , page 527 as conveyed to the State of Wisconsin. Payment Terms $35 , 000 . 00 on June 11 , 1987 and $35 , 000. 00 on each anniversary date of this Contract thereafter ; provided, however , that if the unpaid principal balance on the Contract is greater than $85 , 000 . 00 on July 1 , 1988 , Purchaser shall make monthly payments of $3 , 500 . 00 commencing on July 1 , 1988 and on the first day of each month thereafter . Also provided that on the first day of the fourth month following Purchaser ' s death or permanent disability , monthly payments of $3 , 500 . 00 shall commence hereunder and shall be paid on the first day of each month thereafter . Vendor shall release Lots of not more than 32 acres in size at any time during the Contract upon payment by Purchaser to Vendor of $5 , 500 . 00 per Lot . Each $5 , 500 . 00 payment and each $3 , 500 . 00 monthly payment shall be applied to reduce the next $35 , 000 . 00 required annual payment . Also provided that for each $5 , 500 . 00 paid by Purchaser in total monthly payments , Vendor shall release one additional Lot of not more than 31 acres , upon request of Purchaser . Purchaser shall pay the cost of drafting Partial Releases . Vendor shall convey to Purchaser one parcel of land around farm buildings upon recording of C. S.M. without further payment . Parcel not to exceed 6 acres. S T C 105 r r Y SEPT LC TANK MAINTENANCE A(;I(l:l•:ME.NT c St . Cruix l:uunty 0 Y LJW I-:I:/ BUY EIt 44 lo)(I I'li/ IIOX NIJMBIIA1 t{ Fire Numhur C I T Y/ ST ATE L�G�-�SrJ� ./_.. . !. l I' .15:' 1•I I'I:I(TY L.UCAT10N : ��,G'��a , /1�h .Ia • ;icct ion p2 l' P- N ' k �� W ' Town uf_ QC� _ .- ' St . Cruix CouitLy , ` SubdiviIsJ.un [:ot number 1 __ improper uSe and maltltenaacc of your se1)Lic system cuuld result in I i L S premature"Iit iltire to handle wastes . Proper maintenanCe con- Sitits of pun►pltlg out the septic tank every three years or sooner , it needed , by a licensed 5 t is tank LiumLer . What you put into t.fte :system c:an affect the fUtlCtiolt of the SepLie tank as ,a treat - itwnL Stake in the waste disposal system . tit . Cruix County residents mad+ be eligible: to receive a granL fur n maximum of 60Z of the cost of replacement of a failing s-yatem , which -waS ilk operation prior to July 1 , L978 . St . Cruix County dCc.cl;ted this program it1 August ut 1980 , wLLIt the re(I uiremetlL C.ltar. owrtt! rs of all new stems agree to keep their systems properly maintained . - -The property owner agrees to submit to St . Cruix County Zoning a certification term, sigtiud by the owner and by a master plumber , journeyman plumber , restricLed plumber or it licensed pumper veri- fyf it l, that (1) the oil-site: wastjwater disposal system* is in ,prupur Operating condition and (2) after inspection and pumping ('i'f rt�c-- essary) , the septic tank is less than 1/ 3 full of sludge and scut" . Cu,rtificati.otA form will be sent approximately 30 days prig to three year expiration . 0 0 7/1J1: , flee underSi>;ned , have read the above requirements and agree N ro maintain the private sewage disposal system in accordance with H Like standards Set forth, herein , as set by the Wisconsin Depart- went of Natural Resources . Certification furm must be completed and returned to the St . Croix County Zoning Uffktre within 30 days of the three year expiration date . . SICNEI) D ATE St . C . o i x Cctunty Zoning 'Off ice l' . 0. ilox 9h, llanuno'yed , WI 54015 715-7 16-2239 or 715-425-8363 Sign , date and return to above address . w' NIS Nr '00 G,J�'ll'a nl Goa-.rye l �f/dr/ " r .2 � `P�✓ �a�,�i�Fifr�lr'.v �o�'� �Q�l�!!�s t , Y tb `D 6s 5� P' p �0 k e 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,_ DIVISION P.O. BOX 769 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN F ELATIONS 09(1)&Chapter 145.045) (PATIO N� SE N: O UNICIPALITY: OT NO.: LK.NO.: SUBDIVISION NAME: E Y za Zg N/R E (o MI �as� /4 COUNTY: C�ol`t WNE NAME: MAI i L N N AD A " �soN W r CeUk 410-S &VELOr A/u Soo l6 USE DATES OBSERVATIONS MADE r" O M A DESCRIPTION: ` TESTS: Residence uNv New ❑Replace I JUNE fS /?%� JUNE /6 l��g S0 1LS gx $dtRICNAQD i RATING:S-Sitiie��suitable for system U-Site unsuitable for system /1 ST❑Y MQUfID:❑� O S EJUL E SG k% Jf6N V6#VrfQh+AL_ .1X11 I) ZS If der Percolatioe,Tests are NOT required DESIGN RATE: etl If any portion of the tested area is in the w`� under c.H63.09151(b),indicate: Ct.J�SS � Floodplain,indicate Floodplain elevation: 'Y PROFILE DESCRIPTIONS BORING AL P H R UN ATER-INCHES CHARACTER O SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER H�$ ELEVATION OBS V D EST.HIGH-EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- f /0.0� 94.tp dNl` ? /D 0 i"sic,-s B- 3 o,y<, 4S AC> NoNL ?/0•-7 ,7 cc s R%"$,e MSyc4,e 8- .Ub 933!5 avVK `1.00 "$� QNaf6k 43-t?Q N M S 'k"I e B- /wt %-16 a>v ` y/o.,Sg Qct.�s 3r' �QN�C r7" 5cdcSR s i It B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN H RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. p E —PERIOD2 PERIOD3 PER INCH P- '5,00 4 1,00 3 P_ Z 3.10 NwL 1 97.10 3 P 4 .70 N OCZa -2. > Z < P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevatio at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9A L_ A PA , ) `A-t i SSA�r �I ` Loy i 57't .� �� 60 r 7�2a N AS ►ZQer.► � � — ._ _ f23,9I -- ... _._ --- °— � FouNt�- `�E G��.t.I�+� P107L Two, LpT- 19 I,the undersigned,hereby certify that the soil tests ral orted on this form were-yMade by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and th 1 location of the tests are correct to the best of my knowledge and belief. NAM Print): \ /� TFSTS WERE COMPLETED ON: AQv� J0L1 N50ti fCU%C-u SUYLVE:Yhy4-t /^j<- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 4o? SEco jt, ' /jubsuti )A/i S4ot6 34x4 3rs6-40�U x87-7 CS­T S Lr4A ATURE: DISTRIBUTION: 01ipnuil aniI one copy to Local Amhosity,11,olumly Ownm n1141 Soil Tf%1 R.Slitl•fi395 (R.07182) OVER it